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Congestive Heart Failure in Dogs: Symptoms, Causes, and Treatment

Learn about the warning signs and treatment options for congestive heart failure, a common condition in senior dogs.

Written by Raquel Astacio. Published in May 2023.

As a pet parent, it's important to be aware of the health issues that can arise as our four-legged friends get older. Congestive heart failure is one such condition that every owner should know about  - not only understanding what the symptoms are but also how you can manage it if your pup is diagnosed. 

Keep reading for all things congestive heart failure, from warning signs and risk factors to tips on keeping Fido’s heart healthy!

What is Congestive Heart Failure in Dogs?

Congestive heart failure (CHF) occurs when a dog's heart is unable to pump blood effectively, causing fluid to build up (congest) within the body. The condition can lead to accumulations of fluid in the chest, abdomen, or both, depending on the type of CHF.

Congestive Heart Failure Definition

A damaged heart may struggle to pump blood, leading to blood backing up in the lungs. This can result in fluid accumulation in the lungs, making it challenging for dogs to breathe. Alternatively, fluid may also accumulate in the abdomen, causing swelling and discomfort.

A dog's heart is divided into two sides, similar to that of a human heart. The right side receives oxygen-poor blood from the body and sends it to the lungs to receive oxygen. The left side pumps oxygen-rich blood back out to the body to nourish the tissues. When either side of the heart is damaged or not functioning correctly, it can lead to Congestive Heart Failure.

Right-Sided Vs. Left-Sided CHF - What’s the Difference?

CHF can be described as either right-sided or left-sided. 

Left-sided CHF is the more common type in dogs and occurs when blood backs up in the lungs, causing pulmonary edema. Dogs with left-sided CHF will usually have a cough and/or difficulty breathing.  

Right-sided CHF, on the other hand, occurs when the right side of the heart malfunctions, causing the main circulatory system to become backed up with blood throughout the body. With right-sided CHF, excess fluid typically gathers in the abdomen (ascites) or limbs (peripheral edema).

Left-Sided CHF vs. Right-Sided CHF

Several factors, such as age, genetics, or pre-existing health conditions, can lead to CHF. Early diagnosis and proper treatment are crucial for managing this condition, improving the dog's quality of life, and potentially lengthening their lifespan.

Stages of Congestive Heart Failure in Dogs

Similar to humans, the progression and risk of congestive heart failure (CHF) in dogs are categorized into stages. These stages can help identify early signs of the condition, allowing for early detection and proper management.

The stages of CHF in dogs are as follows:

Stage A: Dogs at risk of developing CHF but currently have no symptoms or structural changes to the heart. Some breeds with a genetic predisposition for CHF include Miniature Poodles, Cocker Spaniels, terrier breeds, and large dogs like Great Danes or Dobermans

Stage B: Dogs that have a heart murmur, indicating turbulent blood flow within the heart, but do not show any symptoms.

Stage B2: Dogs who show structural changes on an x-ray or echocardiogram but are still asymptomatic.

Stage C: In this stage, dogs show clinical signs of congestive heart failure but show improvement when offered medications and treatment.

Stage D: This is referred to as the “end-stage” of the disease, and dogs in this stage typically show severe symptoms and no longer respond to treatment or management.

Stages of CHF

If you have reason to believe your dog may be experiencing symptoms of congestive heart failure or has any risk factors, it's vital to seek veterinary care immediately. Early intervention can significantly improve the outcome and quality of life for dogs diagnosed with CHF.

Symptoms of Congestive Heart Failure in Dogs

Congestive heart failure is a potentially life-threatening condition that can affect any dog, regardless of sex, breed, or age. While CHF can be silent, some of the most common symptoms that pet owners should be aware of include:

  • Coughing (sometimes with foam)
  • Difficulty breathing
  • Increased rate of breathing, even when resting
  • Inability to exercise
  • Fatigue, lethargy, and weakness
  • Cyanotic (blue) gums
  • Distended abdomen
  • Collapse or sudden death

It's important to note that these symptoms may not manifest all at once and may vary depending on the type and stage of CHF. If your dog is experiencing any signs of respiratory distress or trouble breathing, seek emergency veterinary care immediately. Dogs with moderate to severe congestive heart failure symptoms often require hospitalization and immediate medical attention.

What Causes Congestive Heart Failure in Dogs?

Congestive heart failure in dogs can have various causes, but the most common one is myxomatous mitral valve disease (MMVD). Also known as chronic mitral valve disease or degenerative mitral valve disease, MMVD affects the mitral valve on the left side of the heart.

Most common causes of CHF

This valve acts as a doorway between the left atrium and the left ventricle, and when it fails to close, it results in blood leaking through the valve. This leakage leads to left-sided congestive heart failure, which means the left side of the heart is unable to pump enough oxygen-rich blood to the body. While the cause of mitral valve disease is unknown, it seems to have a strong genetic component. MMVD is common in many small-breed dogs.

In large-breed dogs, dilated cardiomyopathy (DCM) is the most common inherited form of heart disease. This condition is characterized by the heart muscle becoming weak and unable to contract properly, which causes the heart to dilate. Breeds that are predisposed to DCM include Doberman Pinschers, Boxers, and Great Danes.

Other causes of CHF in dogs may include:

  • Heart valve disease
  • Defects or “holes” in the walls of the heart (ventricular septal defect)
  • Congenital cardiac defects (patent ductus arteriosus, pulmonic stenosis, and aortic stenosis)
  • Accumulation of fluid in the sac around the heart (pericardial effusion)
  • Heartworm disease
  • Arrhythmias (irregular heartbeat)
  • Increased blood pressure
  • Infection (endocarditis)
  • Tumors (chemodectoma, lymphoma, and hemangiosarcoma)

Understanding the possible causes of CHF can help owners take preventive measures to reduce their dog's risk or get early detection and proper treatment, improving their quality of life and lifespan.

Diagnosing Congestive Heart Failure in Dogs

Diagnosing congestive heart failure in dogs typically begins with a physical exam, which involves listening to the heart and lungs with a stethoscope. Most dogs with CHF will have a heart murmur that will be graded in severity from 1 to 6 (described below). 

A Grade 1 heart murmur is very soft and difficult to hear, even with a stethoscope. Grade 2 murmurs are soft but readily heard, and Grade 3 murmurs are somewhat louder. Grade 4 murmurs are loud and obvious, with Grade 5 being even more intense. And finally, Grade 6 murmurs are overwhelmingly loud and can often be heard (or even felt) without a stethoscope. 

If congestive heart failure is suspected, your veterinarian will likely perform a chest x-ray to scan for heart enlargement or evidence of fluid in the lungs (pulmonary edema). An electrocardiogram (ECG or EKG) may also be used to assess the rate and rhythm of the heart.

In some cases, your veterinarian may even refer your dog to a veterinary cardiologist for further testing, such as an echocardiogram or ultrasound of the heart. An echocardiogram is a valuable tool for identifying the source of a murmur, determining the likely cause of CHF, and evaluating the heart's ability to pump blood effectively. 

Congestive Heart Failure in Dogs Treatment 

When your dog is diagnosed with congestive heart failure (CHF), your veterinarian will likely recommend treatment for the underlying heart disease, if possible, as well as any fluid accumulation. In some cases, an underlying cause, such as heartworm disease, may also be treatable. However, in most cases, CHF cannot be cured. Instead, treatment aims to manage the condition and improve the dog's quality of life.

Treatment options for CHF may include the following:

  • Medications, such as diuretics, to reduce fluid accumulation
  • Blood vessel dilators to reduce the workload on the heart
  • ACE inhibitors to relax blood vessels and increase blood flow
  • Beta-blockers to decrease heart rate and improve heart function
  • Digoxin to improve heart contraction and control heart rhythm
  • Oxygen therapy for dogs with severe breathing difficulties

In some cases, dietary changes may also be recommended to manage CHF effectively. For example, a low-sodium diet may be helpful in reducing fluid accumulation.

While CHF cannot be cured, proper management can significantly improve a dog's quality of life and increase their lifespan. If your dog is diagnosed with this condition, it is essential to follow your veterinarian's recommendations for medication, monitor your dog's symptoms, and attend all recommended follow-up appointments.

How to Prevent Congestive Heart Failure in Dogs

Preventing congestive heart failure in dogs involves reducing their risk factors for developing underlying heart disease. Some tips to help prevent congestive heart failure in dogs include:

  1. Regular vet check-ups: Regular wellness exams can identify any underlying health issues that may lead to heart disease or congestive heart failure.
  2. Maintain a healthy diet: Feed your dog a healthy and balanced diet to help maintain optimal body weight and avoid obesity.
  3. Heartworm prevention: Protect your dog from heartworm disease by giving them regular heartworm prevention medication.
  4. Dental care: Good dental care is essential to prevent infections and inflammation that can ultimately lead to heart disease or congestive heart failure.
  5. Early treatment of heart disease: Early diagnosis and treatment of underlying heart disease can help prevent the development of congestive heart failure.
  6. Maintain a calm, peacful environment: Maintaining a calm and relaxing environment is crucial when you have a dog with congestive heart failure. This condition is a serious ailment, and it can cause a lot of stress for your furry friend. To help manage your dog's stress levels, it's important to create a soothing environment at home.

Pro Tip: One of the best ways to keep your four-legged bestie feeling calm, cool, and collected is to add Melatonin to their daily routine. Not only will this all-natural supplement relieve stress and anxiety, but it also helps regulate a normal sleep cycle! 

By providing adequate care and attention to your dog's health needs, you can help reduce their risk of developing heart disease and congestive heart failure.

FAQs About Congestive Heart Failure in Dogs

“What is the congestive heart failure in dogs prognosis?”

According to our friends at Pet MD, “Once congestive heart failure develops, survival time in dogs is expected to be between 6 to 14 months at stage C. Early detection and proper medical care are keys to improving a dog’s prognosis.”

“What are the signs of worsening CHF in dogs?”

​​Congestive heart failure in dogs progresses through four stages based on the severity of symptoms. Stage D is the most advanced stage and is commonly referred to as the "end-stage" of the disease. In this stage, a dog will typically have severe symptoms that, unfortunately, no longer respond to medications or other treatments.

The symptoms of Stage D CHF may include:

  • Coughing (sometimes with foam)
  • Difficulty breathing
  • Increased respiratory rate/effort even when resting
  • Inability to exercise
  • Fatigue/lethargy/weakness
  • Cyanotic (blue) gums
  • Distended abdomen
  • Collapse or sudden death

As the disease reaches this advanced stage, it’s vital to ensure that the dog is comfortable and free from distress. At this stage, your veterinarian may also recommend various forms of palliative care or end-of-life assistance to help your dog live the rest of their life with dignity and comfort.

“Is congestive heart failure in dogs a painful death?”

Congestive heart failure in dogs is a condition that affects the heart's ability to pump blood throughout the body efficiently, leading to a variety of clinical signs such as coughing, difficulty breathing, and exercise intolerance. While these clinical signs can be concerning and uncomfortable for the dog, congestive heart failure does not necessarily cause a painful death.

If the disease is managed properly and promptly, the dog's symptoms can be managed effectively, and their quality of life can be improved. This may involve medications to improve heart function and dietary modifications to reduce the workload on the heart.

However, if congestive heart failure is left untreated or improperly managed, complications such as a buildup of fluid in the lungs and decreased oxygen supply to the organs can cause discomfort, difficulty breathing, and other symptoms that can lead to a poor quality of life. In these cases, humane euthanasia may be the kindest option for the dog.

“Are dogs in pain with congestive heart failure?”

Dogs with congestive heart failure may not display obvious signs of pain, but it's essential to monitor your dog's behavior, appetite, and energy levels to assess any discomfort caused by the condition. While dogs cannot describe their symptoms like humans, some may show signs of lethargy, reluctance to play, or decreased appetite, which may indicate pain or discomfort. 

“What can I do for my dog with CHF?”

If your dog has congestive heart failure, there are several things you can do to help manage their condition and improve their quality of life:

  1. Follow your veterinarian's recommendations for treatment: Your veterinarian will recommend a treatment plan based on your dog's individual needs. This may include medications to reduce fluid accumulation, blood vessel dilators, ACE inhibitors, or beta-blockers. It's essential to follow the recommended dosage and schedule faithfully.
  2. Monitor your dog's symptoms: Keep a close eye on your dog's behavior, appetite, and energy levels. Report any changes to your veterinarian immediately, as they may indicate a need to adjust medication or treatment.
  3. Maintain a low-stress environment: Avoid situations that may cause your dog undue stress or anxiety, which can worsen their symptoms. Provide a quiet and comfortable environment for your dog to rest.
  4. Offer a healthy diet: A healthy diet, especially one that is low in sodium, can help manage fluid accumulation and reduce strain on the heart. Consult with your veterinarian to determine the best diet for your dog's individual needs.
  5. Maintain regular veterinary check-ups: Regular visits to the veterinarian are essential for monitoring your dog's condition and adjusting the treatment plan as necessary. Your veterinarian may also recommend additional testing, such as blood work or imaging, to assess your dog's heart function.
  6. Consider complementary therapies: Some owners find complementary therapies such as acupuncture or massage helpful in managing a dog's CHF symptoms. However, it's essential to discuss any alternative therapies with your veterinarian first, to ensure they are safe and effective for your dog.

By following these steps and providing informed and compassionate care, you can help improve your dog's quality of life and manage their congestive heart failure effectively.

“Can congestive heart failure be reversed in dogs?”

Congestive heart failure is a condition caused by an underlying heart disease that can cause the heart to weaken over time, leading to a variety of clinical signs, such as coughing, difficulty breathing, and exercise intolerance. While it is not generally considered a curable condition, in some cases, the progression of the disease and associated symptoms can be managed and somewhat reversed with aggressive treatment.


Congestive heart failure in dogs can be a challenging condition, but with careful monitoring and treatment, most dogs can lead a normal, happy life. Ultimately, being informed is key, as understanding the signs and symptoms of congestive heart failure can help pet owners know when their pup might need a little TLC. Knowledge, coupled with the right treatment plan and a little help from your vet, will allow your pup to live a longer, healthier life with CHF. 

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